NOTARY SIGNATURE VERIFICATION

THIS DOCUMENT MUST BE COMPLETED BY A NOTARY PUBLIC

Equipment Financing Agreement: ___________________

Customer Name: _________________________________________________________


Please include a copy of your drivers license; with picture and signature, or another form of photo
identification with signature.

The undersigned hereby acknowledges that he/she has executed all of the documents related to the above-
referenced Lease Agreement, and that no unauthorized signatures appear on same.

"Delivery of this document bearing a facsimile signature or signatures shall have the same force and
effect as if the document bore an original signature."




COPY
OF
DRIVERS
LICENSE






Individual Signers Name,

By: __________________________________________________
(Signature)

Name: ____________________________________


NOTARY CERTIFICATION


Subscribed and sworn to before me on _____________________________________ (Date)

Notary Name (print): ___________________________________________________


Notary Signature: ______________________________________________________

Notary Public for the State of ____________________________

My Commission Expires _______________________________
EFA456
203592-000
GALENA EQUIPMENT RENTAL, LLC